POS1259 AXIAL SPONDYLOARTHRITIS, AGE AND MALE GENDER IMPACT COVID VACCINATION AEs MORE THAN RHEUMATOID ARTHRITIS
Authors: S. Keeling, B. Pan, E. Hutchings, S. Wichuk, M. Osman, A. Singh, A. Sonpar, I. Swartz, W. P. Maksymowych
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatologists recommend vaccination in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) patients, but there are few studies on the occurrence of adverse events (AEs), particularly worsening disease related activity and unrelated immune reactions in these groups. Objectives To evaluate the uptake of COVID vaccination in RA and axSpA patients, compare the frequency of AEs, and identify risk factors associated with vaccine AEs in two prospective cohorts comprised of these patients. Methods The IMPACT study is a monthly survey of two prospective cohorts of established RA and axSpA patients in northern Alberta, Canada from November 2020-2021 who answered at least one or more Redcap surveys through de-identified email link surveying demographics, disease characteristics, COVID symptoms, treatment of RA and axSpA, health care utilization, vaccination status, vaccine AEs and use of cannabis. Univariate analyses evaluated independent variables associated with the dependent variables of (1) any AE, (2) any severe AE, (3) any arthritis flare, and (4) any severe arthritis flare, followed by multivariate analyses of these four dependant variables using all clinically relevant variables from the univariate analysis. Results 773/2167 patients (RA 574, axSpA 197) responded to at least one survey. 32/663 (5%) were single vaccinated, 631 (95%) double vaccinated and 230 (54%) triple vaccinated with 80% receiving Pfizer, 24% Moderna, 28% AstraZeneca and 30% “other”. 456 (69%) reported at least one AE (Figure 1) with 21 (3%) patients seeing a physician for their AE. Increased age was associated with all AEs. RA patients had lower reported AEs versus axSpA patients for all AE definitions except for severe arthritis flares. Generally, males reported worse AEs (Table 1). “Any arthritis flare” was lower in patients reporting cannabis use. Table 1. Summary of Multivariate Level Mixed-Effect Logistic Regression Models Evaluating the IMPACT of RA and axSpA Disease Characteristics on Vaccine AEs Variable Any Adverse EventOR (95 % CI) p value Severe Adverse Event* OR 95 % CI) p value Any Arthritis Flare or Joint Ache Adverse Event OR (95 % CI) p value Any Severe Arthritis Flare or Joint Ache* OR (95 % CI) p value Gender Male 1.47 (0.89 – 2.43)p=0.13 2.10 (1.30-3.41 ) p=0.003 2.05 (1.20 – 3.50) p=0.01 3.97 (1.84 – 8.57 ) p=0.0004 Female Age 1.06 (1.04 – 1.08 ) p&lt;0.01 1.05 (1.03 – 1.06 ) p&lt;0.01 1.03 (1.01 – 1.04 ) p=0.003 1.03 (1.01 – 1.06 ) p=0.004 Rheumatic Disease Type RA 0.42 (0.23 – 0.76 ) p=0.05 0.55 (0.31 – 0.98 ) p=0.04 0.52 (0.28 – 0.98 ) p=0.04 0.78 (0.34 – 1.78)p=0.55 axSpA Steroids Yes 0.85 (0.40 – 1.83) P=0.68 0.66 (0.32 – 1.35) p=0.25 0.84 (0.36 – 1.95) p=0.69 0.38 (0.15 – 0.97 ) p=0.04 No NSAIDS Yes 1.11 (0.81 – 1.52) p=0.51 1.03 (0.75 – 1.41)p=0.86 1.05 (0.74 – 1.48)p=0.80 1.17 (0.73 – 1.89)p=0.52 No Current Disease Activity 0.95 (0.88 – 1.03) p=0.23 0.90 (0.83 – 0.97)p=0.19 0.92 (0.85 – 1.00)p=0.06 0.82 (0.74 – 0.92 ) p=0.001 HAQ 1.08 (0.73 – 1.61) p=0.70 0.77 (0.52 – 1.14 ) p=0.01 0.74 (0.48 – 1.13)p=0.17 0.65 (0.38 – 1.11)p=0.12 Nicotine products Yes 1.33 (0.75 – 2.37) p=0.34 1.42 (0.80 – 2.52)p=0.24 1.15 (0.60 – 2.01)p=0.76 0.97 (0.43 – 2.17)p=0.94 No Cannabis products Yes 0.78 (0.49 – 1.25) p=0.30 0.87 (0.55 – 1.38)p=0.55 0.51 (0.31 – 0.83 ) p=0.07 0.66 (0.35 – 1.26)p=0.21 No DMARDs Yes 1.98 (1.28 – 3.06 ) p=0.002 1.52 (1.01 – 2.28 ) p=0.05 1.43 (0.91 – 2.23) p=0.12 1.86 (1.03 – 3.36 ) p=0.04 No Biologic DMARD Yes 0.72 (0.42 – 1.25) p=0.24 0.79 (0.45 – 1.41) p=0.43 1.20 (0.66 – 2.18 p=0.54 1.39 (0.63 – 3.08)p=0.42 No *Severe = Any of the following: ranked moderate to severe and/or lasting more than 7 days and/or saw physician Conclusion RA and axSpA patients showed high uptake of COVID vaccination with largely minor AEs. Older age and male gender were associated with more general and arthritis specific AEs. The association of any AE and/or arthritis-specific AEs in SpA versus RA patients is a novel finding which may correlate with the male predominance of SpA. The association of cannabis with fewer arthritis AEs may reflect the nociceptive properties of cannabis. Acknowledgements Epidemiology Coordinating and Research (EPICORE) Centre provided support for the REDCAP survey and biostatistical analyses. Disclosure of Interests Stephanie Keeling Speakers bureau: Pfizer, Abbvie, GSK, UCB, Consultant of: Abbvie, GSK, UCB, AstraZeneca, Sandoz, Pfizer, Grant/research support from: Abbvie, Sandoz, Merck, UCB, Bo Pan: None declared, Edna Hutchings Shareholder of: BMS, Stephanie Wichuk: None declared, Mohammed Osman Speakers bureau: Boehringer Ingelheim, Takeda Pharmaceuticals, Grant/research support from: Boehringer Ingelheim and CSL-Behring, Ameeta Singh: None declared, Ashlesha Sonpar Speakers bureau: Novartis, Ilan Swartz: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celegene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB